Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline.

BACKGROUND: The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition. OBJECTIVE: In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline. METHODS: An exploratory data analysis was conducted using longitudinal 2-year data from the FINGER study (n = 1,120). A change score analysis was applied using HRQoL utilities and total medical care costs as outcome. HRQoL utilities were derived from the Short Form Health Survey-36 (SF-36). Total care costs comprised visits to a general practitioner, medical specialist, nurse, and days at hospital. Analyses were adjusted for activities of daily living (ADL) and depressive symptoms. RESULTS: Although univariable analysis showed an association between cognition and HRQoL utilities, multivariable analysis showed no association between cognition, HRQoL utilities and total care costs. A one-unit increase in ADL limitations was associated with a -0.006 (p < 0.001) decrease in HRQoL utilities and a one-unit increase in depressive symptoms was associated with a -0.004 (p < 0.001) decrease in HRQoL utilities. CONCLUSION: The level of cognition in people at-risk for cognitive decline does not seem to be associated with HRQoL utilities. Future research should examine the level at which cognitive decline starts to affect HRQoL and care costs. Ideally, this would be done by means of cross-validation in populations with various stages of cognitive functioning and decline.

Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program.

INTRODUCTION: The aim of this study was to estimate the potential cost-effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. METHODS: A life-time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER program. RESULTS: Costs were 1,653,275 and 1,635,346 SEK and quality-adjusted life years (QALYs) were 8.636 and 8.679 for usual care and the FINGER program, respectively, resulting in savings of 16,928 SEK (2023 US$) and 0.043 QALY gains per person, supporting extended dominance for the FINGER program. A total of 1623 dementia cases were avoided with 0.17 fewer person-years living with dementia. The sensitivity analysis confirmed the conclusions in most scenarios. DISCUSSION: The model provides support that programs like FINGER have the potential to be cost-effective in preventing dementia. Results at the individual level are rather modest, but the societal benefits can be substantial because of the large potential target population.

Lifestyle factors on the risks of ischemic and hemorrhagic stroke.

BACKGROUND: The joint effects of different lifestyle factors on stroke risk are still to some extent unclear, especially regarding hemorrhagic stroke. METHODS: We prospectively investigated the association of different indicators of lifestyle (smoking, body mass index, physical activity, and vegetable and alcohol consumption) with total and type-specific stroke incidence among 36 686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline. RESULTS: During a mean follow-up period of 13.7 years, 1478 people developed an incident stroke event (1167 ischemic and 311 hemorrhagic). The multivariate-adjusted (age, sex, education, family history of stroke, history of diabetes mellitus, systolic blood pressure, and serum total cholesterol level) hazard ratios associated with adherence to 0 to 1 (reference group), 2, 3, 4, and 5 healthy lifestyle indicators were 1, 0.66, 0.57, 0.51, and 0.33 (P < .001 for trend) for total stroke; 1, 0.67, 0.60, 0.50, and 0.30 (P < .001 for trend) for ischemic stroke; and 1, 0.63, 0.49, 0.49, and 0.40 (P < .001 for trend) for hemorrhagic stroke, respectively. These inverse associations were similar in both men and women. The partial population attributable risk percentages associated with adherence to 3, 4, and 5 healthy lifestyle indicators were 26.3%, 43.8%, and 54.6% for total stroke; 22.7%, 45.3%, and 59.7% for ischemic stroke; and 35.0%, 35.0%, and 36.1% for hemorrhagic stroke, respectively. CONCLUSION: Healthy lifestyle factors are associated with a lower risk of stroke, and there is a graded inverse association between the number of healthy lifestyle indicators and the risks of total, ischemic, and hemorrhagic stroke.

Trends in health status and the use of services among the 80-84-year-old Finnish war veterans during 1992 and 2004.

AIM: The aim of this study was to compare the differences in health state, functional capacity and the use of social and health services among the 80-84-year-old Finnish Second World War veterans in 1992 and 2004 and to describe the possible effects of the improvements made based on the results after 1992. METHODS: The Veteran Projects were conducted among the veterans using a postal questionnaire. In 1992, the questionnaire was sent to all veterans (n = 242,720) living in Finland, and in 2004 to 5750 veterans who had participated in the study in 1992. The comparable age groups of veterans aged 80-84 years were used. The data were analysed by descriptive statistics and binary logistic regression analysis. Analyses were conducted separately for men with and without disability and for all women. RESULTS: The proportion of men with good self-reported health, painlessness, normal memory and vision and who were able to walk 500 m without difficulties, significantly increased, as did the proportion of women with normal memory and vision. The prevalence of many diseases increased, but diseases appeared to be less disabling in 2004 than 1992. The need for hospital care decreased and the use of rehabilitation services increased, but the increased use of rehabilitation services was not indicative of the ability to walk 500 m. CONCLUSIONS: Self-rated health and functional capacity improved and the need for hospital care decreased among veterans, although the prevalence of many diseases increased during the follow-up. Rehabilitation was not associated with the ability to walk 500 m without difficulties.

Mortality according to a prior assessment of biological age.

BACKGROUND: Measures of biological age have not been proven to predict mortality. This study examines whether measuring biological age improves the prediction of mortality. METHODS: Prospective study from 1981 to 2001 of 397 male London Civil Servants. Two indices of biological ageing were calculated. RESULTS: 60 men died and both indices of biological ageing were related to survival. In a model that mutually adjusted for both chronological and biological age, biological age using index one was statistically significant with a hazard ratio (HR) of 1.11 per year of age (95% confidence interval 1.01 - 1.21, P=0.03). The useful components of the measures of biological ageing were systolic blood pressure (HR 1.31 for 1SD), albumin, and, to a lesser degree, Erythrocyte Sedimentation Rate (ESR). Greying of the hair, skin inelasticity, arcus senilis, and baldness were not predictors of mortality as measured by our methods. Similarly serum cholesterol, creatinine, calcium and urate could be excluded. A modified index was developed including systolic pressure, ESR, urea, albumin, and bilirubin and had a sensitivity of 78% and specificity of 51% in predicting subjects who died. CONCLUSION: This study represents 'proof of principle' in demonstrating the utility and validity of measuring biological age. The modified index needs to be tested prospectively.